A user's guide to calculate return on investment for artificial intelligence algorithms and imaging technologies

Radiology departments are under increasing pressure to assess artificial intelligence (AI) algorithms, advanced imaging hardware, and digital workflow solutions. However, leadership often lacks formal training in financial analysis to support these evaluations. ROI analysis offers a clear and structured way to measure the net financial impact of new and existing technologies. This educational review provides a practical toolkit adapted from the AHRQ framework, specifically designed for radiology clinical, finance, and informatics leaders. It covers key metrics such as ROI, cost-effectiveness analysis, incremental cost-effectiveness ratio, and net present value (NPV). The review also highlights critical design considerations, including defining scope, establishing a time horizon, selecting comparison groups, and identifying financial contributors to benefits (gains) and costs in ROI calculations. An illustrative case study using an AI tool for chest CT interpretation demonstrates common pitfalls, like exaggerated financial benefits due to vendor incentives and publication bias, as well as frequently overlooked costs such as IT integration, radiologist training, and maintenance. By systematically applying this framework, radiology leaders can make more transparent and financially sound decisions when evaluating AI and other imaging innovations.